Scientific letter
Acute infectious diarrhoea and empirical antibiotic therapy sensitivity. Single-centre review
Revisión de la sensibilidad en el tratamiento antibiótico empírico de la diarrea aguda infecciosa
Ángela Martina Montero Moretóna,
, Luis Cabezudo Molledab, María Antonia García Castroc, Moisés García Bravoc, Almudena Tinajas Puertasc, Fernando Santos Santamartaa, Marta Cimavilla Romána, Seila Fernández Fernándezd, Sergio Maestro Antolína, Antonio Germán Pérez Millána
Corresponding author
a Gastroenterology Department, Complejo Asistencial Universitario de Palencia, Spain
b Internal Medicine Department, Complejo Asistencial Universitario de Palencia, Spain
c Microbiology Department, Complejo Asistencial Universitario de Palencia, Spain
d Medical Oncology Department, Complejo Asistencial Universitario de Palencia, Spain
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F: Línea de grapas del muñón de la anterior apendicectomía.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco Miguel González-Valverde, Pedro López-Morales, Lucía Sánchez-Alonso" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Francisco Miguel" "apellidos" => "González-Valverde" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "López-Morales" ] 2 => array:2 [ "nombre" => "Lucía" "apellidos" => "Sánchez-Alonso" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570521000200?idApp=UINPBA00004N" "url" => "/02105705/00000045000000S1/v1_202204191527/S0210570521000200/v1_202204191527/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0210570521003022" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2021.10.002" "estado" => "S300" "fechaPublicacion" => "2022-04-01" "aid" => "1883" "copyright" => "Elsevier España, S.L.U." 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(A, B) H&E stain low-magnification (×20 and ×40 respectively) shows lymphoplasmacytic portal infiltrate with focal disruption of the limiting plate. No evidence was found of histologic cholestasis, fibrosis or iron deposit. (C) Immunohistochemical study of plasma cells expressing CD38. 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Coli</span>, etc.) and protozoa (<span class="elsevierStyleItalic">Cryptosporidium, Giardia, Entamoeba</span>, etc.).</p><p id="par0010" class="elsevierStylePara elsevierViewall">Different treatments can be useful since supportive management to hospitalization.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The use of empirical antibiotic therapy in acute diarrhoea (AD) is unclear. Recent studies demonstrate that the use of antibiotic has not statistical difference in terms of length of hospital stay<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and they can cause side effects as promotion of bacterial resistance, eradication of intestinal normal flora and fungal overgrowth.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Fluoroquinolones has been historically the main therapy when indicated, with <span class="elsevierStyleItalic">Salmonella</span> infection as leading target, despite the decline in the last 10 years. Empirical therapy depends on suspicion. Recent studies define <span class="elsevierStyleItalic">Campylobacter</span> spp. as the main infectious agent in United States and Europe causing AD being resistant to fluoroquinolones over the 90% of cases, reason why macrolides are becoming first-line treatment.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A descriptive retrospective study was carried out including stool cultures with pathogen isolation collected between 2018 and 2019 in patients older than 14 years old from a tertiary hospital with a health area of more than 160,000 people. The variables analysed were age, sex, place of request for stool culture (hospitalization, Emergency Room, Fist Care and Specialty Care Medicine), origin of the patient (Urban or Rural area), isolated pathogens and sensitivity and antibiotic resistance.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Pathogens isolated were collected in the following groups: <span class="elsevierStyleItalic">Aeromonas, Campylobacter spp</span>, <span class="elsevierStyleItalic">Salmonella spp</span>, <span class="elsevierStyleItalic">Yersinia spp</span> and Other (<span class="elsevierStyleItalic">Plesiomonas</span>, <span class="elsevierStyleItalic">Helicobacter Pullorum and Shigella</span>). Antibiotic sensitivity and resistance were tested against fluoroquinolones (Ciprofloxacin) and macrolides (Erythromycin).</p><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 465 stool culture were analysed between January 2018 and December 2019. The epidemiological characteristics of the patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. 257 stools became from men (55.3%) and there were not statistically significant differences between male and female. The average age was 55.05 years old (SD<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>22.60). First Care was the main place of request for stool cultures (54.19%) followed by the Emergency Room (22.15%) and hospitalized patients (15.92%). 54% of First Care stool cultures became from urban areas, without statistical significance differences.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Campylobacter</span> spp. was isolated in 251 stools (53.99%) followed by <span class="elsevierStyleItalic">Salmonella</span> spp. (20.22%) and <span class="elsevierStyleItalic">Aeromonas</span> spp. (17.63%) without statistical significance differences between 2018 and 2019. Sensitivity analysis showed that 98.4% of <span class="elsevierStyleItalic">Campylobacter</span> spp. were sensitive to Azithromycin and 1.6% resistant, while 8.8% sensitive to Ciprofloxacin. 100% of <span class="elsevierStyleItalic">Salmonella</span> spp. analysed were sensitive to Ciprofloxacin.</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Campylobacter</span> spp. has replaced pathogens as <span class="elsevierStyleItalic">Salmonella spp.</span> and enterotoxigenic <span class="elsevierStyleItalic">E. coli</span> as the leading bacteria related to AD of infectious aetiology in developed countries nowadays. Empirical antibiotic therapy, limited to patients with comorbidity, advanced age, and severe disease, constitutes a therapeutic tool of great interest in these cases, being necessary to adjust to the most frequent pathogens.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The findings of our study provide one more justification to impose macrolides as first-line empirical therapy being sensitive over the 95% of the cases of Campylobacter, limiting quinolones to patients with a high suspicion of salmonellosis since <span class="elsevierStyleItalic">Campylobacter</span> spp. has been resistant in more than 90% of the analysed cases. Unfortunately, macrolide-resistant <span class="elsevierStyleItalic">Campylobacter</span> strains are progressively increasing, but macrolide resistance in Europe is still below 5%.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Although <span class="elsevierStyleItalic">Aeromona</span> spp. has been found in a non-negligible number of stool cultures analysed, the role of <span class="elsevierStyleItalic">Aeromona</span> spp. in gastrointestinal disease has been debated. Even recent studies support pathogenic properties, there are not enough evidence to conclude the role in infectious diarrhoea and the need of specific treatment when detected in stool culture.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Constant analysis of etiological agents in infectious pathologies is indispensable. Over time and, on each geographical area, infectious agents change as well as their sensitivity and resistance to antibiotic treatments, that makes essential a periodic study.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">All <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>465 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age (years)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.05<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>22.602 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14–100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Gender, n(%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">257 (55.27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">208 (44.73) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Provenance service,</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">(%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">First care</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">252 (54.19) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Urban \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">146 (57.94) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Rural \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">106 (42.06) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Emergency room</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">103 (22.15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hospitalization</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 (15.92) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Specialty care medicine</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (7.74) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2880358.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics of the patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Troeger" 1 => "B.F. Blacker" 2 => "I.A. Khalil" 3 => "P.C. Rao" 4 => "S. Cao" 5 => "S.R. Zimsen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(18)30362-1" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2018" "volumen" => "18" "paginaInicial" => "1211" "paginaFinal" => "1228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30243583" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antimicrobial therapy of acute diarrhoea: a clinical review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. 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DuPont" 2 => "B.A. Connor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ajg.2016.126" "Revista" => array:6 [ "tituloSerie" => "AM J Gastroenterol" "fecha" => "2016" "volumen" => "111" "paginaInicial" => "602" "paginaFinal" => "622" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27068718" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emerging agents of gastroenteritis: <span class="elsevierStyleItalic">Aeromonas</span> Plesiomonas, and the diarrheagenic pathotypes of <span class="elsevierStyleItalic">Escherichia coli</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.N. Schuetz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.semdp.2019.04.012" "Revista" => array:6 [ "tituloSerie" => "Semin Diagn Pathol" "fecha" => "2019" "volumen" => "36" "paginaInicial" => "187" "paginaFinal" => "192" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31036328" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02105705/00000045000000S1/v1_202204191527/S0210570521001862/v1_202204191527/en/main.assets" "Apartado" => array:4 [ "identificador" => "93414" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Miscelánea" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105705/00000045000000S1/v1_202204191527/S0210570521001862/v1_202204191527/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570521001862?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 1 | 2 |
| 2024 October | 27 | 4 | 31 |
| 2024 September | 27 | 11 | 38 |
| 2024 August | 31 | 12 | 43 |
| 2024 July | 18 | 4 | 22 |
| 2024 June | 19 | 4 | 23 |
| 2024 May | 21 | 12 | 33 |
| 2024 April | 16 | 17 | 33 |
| 2024 March | 29 | 14 | 43 |
| 2024 February | 23 | 11 | 34 |
| 2024 January | 17 | 5 | 22 |
| 2023 December | 20 | 4 | 24 |
| 2023 November | 28 | 3 | 31 |
| 2023 October | 45 | 4 | 49 |
| 2023 September | 23 | 1 | 24 |
| 2023 August | 21 | 1 | 22 |
| 2023 July | 31 | 2 | 33 |
| 2023 June | 28 | 6 | 34 |
| 2023 May | 27 | 4 | 31 |
| 2023 April | 24 | 6 | 30 |
| 2023 March | 11 | 8 | 19 |
| 2023 February | 16 | 10 | 26 |
| 2023 January | 13 | 14 | 27 |
| 2022 December | 13 | 13 | 26 |
| 2022 November | 8 | 6 | 14 |
| 2022 September | 1 | 0 | 1 |
| 2022 August | 3 | 0 | 3 |
| 2022 June | 10 | 4 | 14 |
| 2022 April | 1 | 0 | 1 |
| 2022 February | 0 | 2 | 2 |
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